Decision-making in primary hyperparathyroidism in older patients: surgical or conservative management?
Abstract
Primary hyperparathyroidism (PHPT) is a frequent endocrine disorder, with prevalence increasing with age, affecting approximately 1.5% of adults aged over 65. While management is well codified before the age of 50, with surgery being preferred, recommendations for older individuals are less clear. In this population, however, surgery is still the only curative option, and several studies demonstrated improvement in cognitive and neuropsychiatric symptoms, following parathyroidectomy. However, this indication must be weighed against the patient's co-morbidities, frailty and wishes. Drug-based alternatives are a valid option for patients unable or unwilling to undergo surgery. The fundamental question, however, is to evaluate the suitability of one treatment over another, depending on the patient's phenotype. A transdisciplinary approach involving endocrinologists, endocrine surgeons and geriatricians can ensure personalized care. A robust older patient may benefit from surgery, just like a younger patient, whereas a frail patient would benefit more from conservative management. In what are known as "pre-frail" patients, comprehensive geriatric assessment can optimize of the patient's general condition prior to surgery, and help anticipate postoperative complications. The present article firstly describes the clinical and biological specificities of PHPT in older adults, secondly compares the therapeutic strategies available, and thirdly identifies geriatric markers to guide the therapeutic decision.
Related
- Bezoar ileus in patients with previous abdominal surgery: an observational comparison of conservative and surgical management.
- Surgical management of presternal recurrence in hyperparathyroidism related to chronic kidney disease.
- Conservative Surgical Management of Post-Cesarean Uterine Incisional Necrosis: A Case Report.
- Triage models for surgical decision-making in patients with shoulder pain: an integrative review
- The epidemiology of cancer patients with proximal femoral lesions and evaluation of surgical decision tools: A prospective cohort study☆
BibTeX
@article{letissier2026decisionmaking,
title = {{Decision-making in primary hyperparathyroidism in older patients: surgical or conservative management?}},
author = {Nathanaël Bassas Letissier and Evelyne Liuu and Gianluca Donatini and Aurélie Miot and Sophie Deshayes and Marc Paccalin and Helena Mosbah},
journal = {Annales d'Endocrinologie = Annals of Endocrinology},
year = {2026},
month = oct,
doi = {10.1016/j.ando.2026.102602},
url = {https://hal.science/hal-05773714v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Decision-making in primary hyperparathyroidism in older patients: surgical or conservative management?
AU - Nathanaël Bassas Letissier
AU - Evelyne Liuu
AU - Gianluca Donatini
AU - Aurélie Miot
AU - Sophie Deshayes
AU - Marc Paccalin
AU - Helena Mosbah
PY - 2026
DA - 2026/10/01
JO - Annales d'Endocrinologie = Annals of Endocrinology
DO - 10.1016/j.ando.2026.102602
UR - https://hal.science/hal-05773714v1
AB - Primary hyperparathyroidism (PHPT) is a frequent endocrine disorder, with prevalence increasing with age, affecting approximately 1.5% of adults aged over 65. While management is well codified before the age of 50, with surgery being preferred, recommendations for older individuals are less clear. In this population, however, surgery is still the only curative option, and several studies demonstrated improvement in cognitive and neuropsychiatric symptoms, following parathyroidectomy. However, this indication must be weighed against the patient's co-morbidities, frailty and wishes. Drug-based alternatives are a valid option for patients unable or unwilling to undergo surgery. The fundamental question, however, is to evaluate the suitability of one treatment over another, depending on the patient's phenotype. A transdisciplinary approach involving endocrinologists, endocrine surgeons and geriatricians can ensure personalized care. A robust older patient may benefit from surgery, just like a younger patient, whereas a frail patient would benefit more from conservative management. In what are known as "pre-frail" patients, comprehensive geriatric assessment can optimize of the patient's general condition prior to surgery, and help anticipate postoperative complications. The present article firstly describes the clinical and biological specificities of PHPT in older adults, secondly compares the therapeutic strategies available, and thirdly identifies geriatric markers to guide the therapeutic decision.
SN - 0003-4266
SN - 2213-3941
ER -